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General NPI Number Information
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NPI Number | 1710113402
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Entity Type | Individual
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Provider Name | JESSIKA SILVIA DINGWALL M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 1200 COLLEGE DR
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-5868
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Country | US
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Telephone | 307-350-8577
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Fax | 307-875-8800
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Provider Business Mailing Address
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Address Line | 3851 ROGER BROOKE DR MCHE-QD (CREDS)
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101248207
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | TL3383
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License Number State | WY
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